32C-296 .
A' ..
WINDOW WORLD HIC #104000
( 344 I / 56 Dimock St.
• Leeds, MA 01053
)--.X (,� S �/ r Telephone 586 -8712
777 4 C/C/ c i CONTRACT
Date /1/..7 d 20 5
This agreement, between A/41—C- 01.441
1
(Owner)
of �f G I � - � - y s1 .�C. ) A-� - x -- , and
(Address)
WINDOW WORLD OF LEEDS, MASSACHUSETTS
Phone - '0 4
SPECIFICATIONS
L -c..)1 e' ev C o/e L- . / L-e,
—27 r --C-L 1 1f ic. e / ��1 �L -*lid. d e.
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/,v )l l/ r 1�- >/ ce iL.�' Cj f J It �f -C/ S C ��c )23
-41/ 1 " -)
bve x =fir
on the premises located at ` 0 ( L 7 S/ a total cost of i �- °
With this order owner pays down the sum of $ ,C3 a l.'> : ca c
Owner agrees on completion of said work by the Contractor to pay the sum of $ c:7 dollars
(8 ).
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be
binding unless in writing signed by both parties.
'VINDOGUARANTEE
Window World's glass is guaranteed for. from date above not to fog up between the panes of glass. All other parts will
be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked
glass after 90 days from date above or any damage resulting from neglect, abuse, or acts of God. Condensation build up on the glass is
caused from high humidify levels and poor ventilation within the hose_ therefore there is no guarantee that this condition will not occur.
In witness whereof, I have hereunto signed my name this P _ S rj day of /1 " 20�
by 1 i
(C racto Authorized Agent) (Owner)
(Joint Owner)
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he /she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
' . The Comfnon wealth of Massachusetts
._.: Department of Industrial Accidents
, Office of Investigations
600 Washington Street
Boston, MA 02111
:Ty www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors/EIectricians /Plumbers
Applicant Information Please Print Legibly •
Name ( Business /Organization/Individual): WINDOW WORLD
Address: 56 Dimock Street
Leeds, MA 01053
City /State /Zip: 586 -8712 Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1.0 I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. E] New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
/ /'' ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
i
h
d i
h
ffi
ocers have exercised their 11.
3. ❑ I am a homeowner doing all work ❑ Plumbing repairs or additions
myself. No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' i 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. if the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: _
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjuo, that the information provided above is true and correct.
Signature: --. Date: 7/—.1-4-4
Phon - L j �'4 771
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Jr .� C y / e t( 6 77 P'4
1 / License Number
4 4 / /44 /.> . ic yT L-- c.-- S c44 i 4/0 //D
Address Expiration Date
nature 2 Telephone
9. Registered Home lmproveinerit Contractor , ., : Not Applicable ❑
/d J e 3
Company Name Regis ration Number
WINDOW WORLD G �� /10
Address
56 Dimock Street Expira ion Date
Leeds, MA 01053
586 -8712 Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
11. - Horne Owner Egenption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CIVIR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemegt Windows Alteration(s) n Roofing n
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [I]] Decks [[1 Siding [O] Other [O]
Brief Description of Proposed"' —. '
Work: .�o� "�i /� L- v /�7-� -�il�l �� K 3d
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rot - Sheet
6a. If New house and or addition to existing housing,: complete the fo[UOWinq:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Wit building conform to the Building and Zoning regulations? Yes No .
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN.
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
rte._
j C L ( , as Owne uthorize
ge t hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my nowledge
ffielief.
Signed - un-d'err the pains and penalties of perjury.
G14 Lk_
Print Name
/A- p'
Signature_of ( ne i Date / •
• . ^�
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zonmg
This column to be fiiled in by
Building Department
- --- - ' ~ |- -- -------
Lot Size
/ ---- F ----------------'�
Frontage �'-'---------------� '------ �---------------
Setbacks Front
—
Side
Rear
Building Height � F [---�
Bldg. Square Footage --- _
„_
Open Space Footage Y6 F ----
(Lot area minus bldg &paved
parking)
# of Parking Spaces
Fill: --- ---- ---�-- -^ -- --
(vo lume & Location) '-------------�---�--------- ----�
A. Has a Speciat Permit/Variance/Finding ever been issued for/on the site?
�� 0 0
NO �~� DON7KNOVY �~/ YES v��
IF ¥ES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� DONT KNOW Y[S
��
r -------
IF YES: enter Book Page � and/or Document #
„
�� ��
B. Does the �tecontain a brook, body uf water orvvetiands? NO �~ �� � D0NTKNOVY «_/ YES �_�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained x Obtained
~-�
�-\ Date Issued:
r --------------��
»~� �-� ' '
C. Do any signs exist on the propert �� property? YES �~� NO �~ ��
/
IF YES, describe size, type and location:
- -- -
D. Are there any proposed changes to or additions of signs intended forte property ? YES 0 NO C
----------------------------------- -- --
|FYES, describe size type and location:
E. Wil the construction activty disturb (clearing, ring, gradingexcavation, or filling) over 1 acre or is it part of a common pian
that will disturb aver 1 acre? YEGK ) NO � )
�� ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Departrn use onC
City of Northampton tus oferr>c�tt
Building Department Cctr Cti#/Onue�rra Fermi
21 Main Street Seierts
Sta
x
Si- ? 2 J � Room 100 Water/Wetfi uatfabatcty
Northampton, MA 0106 Two Sets o> Structural r?tans°
p ns hone
413-587;. 24 Fax 413 - 587 -1272 Plot/Stte-Pta'
n
a
Otter� t .
A�PEUTION TO CONST
RUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to > be completed, by office
map- Lot Unit
(-to - L� 7
� � Zone Overlay District
Elm St District CB;Distnct if
SECTION 2 - PROPE OWNERSHIP /AUTHORIZED A GE NT
2.1 Owner of Record:
i'! `r C' � rJ vi /= i0 -:��� 1 . G —L L� te r!
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorize A gent:
L� �k - S � t s ��s � c r c t L — 044 Name (Print) Current Mailing Address:
Si.``ture Telephone
SE 3 - ESTIMATED C ONSTRUCTIO N COSTS
Item Estimated Cost (Dollars) to permit applica
1. Building (a) Building Permit Fee
2. Electrical • (b);Estimated Total Cost of
Construction from (6)
3. Plumbing Building Perm Fee
4. Mechanical (HVAC)
5. Fire Protection
`/ 3��
41 ?5--
6. Total = (1 + 2 + 3 + 4 + 5) 1 T�� C heck N
This - Sect For Official Use only
Date
Budding Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
i.
• .
BP- 2010 -0340
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0340
Proiect # JS- 2010 - 000461
Est. Cost: $3435.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN CORBETT 078297
Lot Size(sq. ft.): 18817 Owner: EVERETT MALCOLM G
Zoning: URC(100)/ Applicant: JOHN CORBETT
AT: 40 VALLEY ST
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586 - 8712
LEEDSMA01053 ISSUED ON:9/30/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 9/30/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo